Scope of Practice Review comes under fire

The Unleashing the Potential of our Health Workforce - Scope of Practice Review final report was delivered last week. It’s caused a stir among Australia’s peak doctor groups but has been welcomed by the nation’s nurses and midwives.

The review was led by Professor Mark Cormack who calls it an “ambitious program of work to reform our primary care workforce to deliver high quality, equitable, integrated and sustainable healthcare for Australian communities”.

The report contains 18 recommendations.

The Royal Australian College of General Practitioners (RACGP) as well as the Australian Medical Association (AMA) are urging the government to be cautious in its assessment and response to the report.

More costs, more delays

The RACGP warns that the recommendations may sound good but will create a more costly health care system, delays to care and an increase in out-of-pocket costs to patients.

“This is a report, not a plan, but its recommendations will raid Medicare and set us up for a two-tiered health system where those who can afford to see a GP will, and those who can’t, don’t,” RACGP President Dr Nicole Higgins said.

The RACGP slammed the review’s recommendation for direct referrals to specialists for “something a GP can do” and can lead to “inappropriate referrals.”

“This isn’t gatekeeping, it’s coordination of a patient’s care by a GP who knows them, their history, and who can make the link between the medical implications of different types of care and results and a patient’s health and needs,” Dr Higgins said.

“Dropping that coordination will lead to a free for all, without a GP’s oversight to ensure care is necessary and in a patient’s interest, and no doctors and other health professionals duplicating each other’s work,” she said.

“There’s also a risk of more inappropriate referrals as patients are sent to non-GP specialists in greater numbers, including specialisations already facing workforce shortages,” Dr Higgins said.

That will increase out-of-pocket costs for patients already struggling with cost-of-living pressures, and delay their care as they wait to see specialists already in short supply.”

UK comparisons

The AMA warns of adopting an NHS style approach that had “doomed primary care” in the United Kingdom.

“We have always been very supportive of enhancing collaborative multidisciplinary care and ensuring all health professionals can work to their full breadth of scope in primary care, but this requires better funding models and improvements to the many reforms currently underway in general practice, such as MyMedicare,” AMA President Dr Danielle McMullen said.

The RACGP also raised the situation in the UK.

“Rather than investing in general practice, they substituted less qualified health professionals without medical training for GPs – it was disastrous. There was not just lower quality care, but real harm, including misdiagnosis that ended with a patient’s death,” Dr Higgins said.

The nursing perspective

Not every health practitioner group criticised the review. Australia’s nurses have welcomed the findings and recommendations.

“The community benefits when the nursing profession is empowered and supported to work to its full scope of practice,” the Australian College of Nursing (ACN) CEO, Professor Kathryn Zeitz said.

“The review acknowledges and explains the restrictions, barriers, and inconsistencies across states and territories that prevent nurses, nurse practitioners and midwives from working to the full capability of their skills, education and experience,” she said.

“ACN agrees with Minister Butler when he said in releasing the final report ‘removing these barriers would make it easier for Australians to get high quality care, when and where they need it, without waiting weeks for an appointment’,” Professor Zeitz said.

Professor Zeitz said the review findings highlight that general community awareness of the scope of practice of all health professionals is limited.

Some cautious support

There was some support from the doctor groups for the review.

The RACGP conditionally supports the recommendation of a body to provide evidence-based advice on workforce innovation (as long as it’s politically independent). It also gives “cautious support” to the recommendation for the funding and introduction of a new “blended payment” to enable access to multidisciplinary health care.

The AMA supports the recommendation of greater consistency in regulation across jurisdictions.

The AMA said decisions about standards of training and clinical practice must be made by independent, profession-led bodies, not politicians as the report suggests.

“Regulation of health professionals exists to protect the community and ensure the highest standards of care for patients, and this is not something that politicians should be meddling in,” Dr McMullen said.